C linical review
Partnership in care: paediatric nursing model Michael Farrell, Hospitals for Sick Children, London In 1988, Casey developed her partnership in care model for use within the paediatric healthcare setting as she felt that other models did not recognize or emphasize concepts that she deemed essential for effective paediatric care. This has now been adopted by the Hospitals for Sick Children as the model of care.
‘T
A he care of children, well or sick, is best carried out by their families, with varying degrees of assistance from members of a suitably qualified healthcare team whenever necessary’ (Casey, 1988). The unique contribution that parents make to the lives of their children has been well established and recognized. Any care of the sick child requires the involvement of the parents if the care is to be effective (Platt, 1959). A similar view is expressed in the Court report (1976) which states that healthcare professionals should provide an environment that will: ‘achieve a unity of preventive and curative medicine which in cludes partnership with parents.’ This re port went on to state that it is only when a partnership exists between significant family carers and healthcare workers that the sick child’s recovery will be promoted. Unlike other nursing models, Casey’s model clearly identifies the significant con tribution that parents make to the care of the sick child. This concept forms the fundamental philosophy of the model.
Concepts Casey’s partnership in care model com prises five main concepts: The child From birth, the needs of a child are very much dependent on other people. The ma jority of these needs are met by the child’s parents or other family members. How ever, as children develop new skills and knowledge, they are more able to meet their own needs. This enables them to become more independent from their primary caregivers until that time when they achieve full independence.
Mr Farrell is Charge Nurse, Intensive Care Unit, Hospitals for Sick Children, Great Ormond Street, London
Health Casey defines health as being that state of optimal physical and mental wellbeing that should be present at all times if a child is to achieve his/her full potential. If an un
British Journal of Nursing, 1992,Vol l,N o4
identified or unrectified health deficit is present, this may compromise the child’s physical, psychological, intellectual, social and spiritual development. Environment A child’s development can be affected by a number of stimuli. Casey considers that those which originate from external sources, i.e. from outside the self, occur as a result of a child’s environment. She fur ther considers that the child needs to per ceive that the external environment is safe, caring and loving if development and inde pendence are to be promoted. Family Casey recognizes the difficulties inherent in trying to define the concept of the family. For the purposes of the model, the family is described as a unit of individuals who have the major responsibility for the giving of care to the child and exercise a strong influence upon the child’s development. While parents take on the main caring re sponsibilities, the model does not preclude the involvement and influence of others. Care given by family members, or in deed the care that the child gives himself/herself, is known as family care. This encompasses care activities that meet the child’s everyday needs. Paediatric nurse The paediatric nurse has a number of re sponsibilities to fulfil in order to function effectively as a healthcare professional. Casey describes the concept of the nurse with regard to the actions that she performs (Fig- /)■ Care: The partnership in care model ident ifies the care given by the nurse as nursing care. In the context of the model, the nurse should only perform nursing procedures or give skilled nursing care when it is appro priate, i.e. the nurse will only become in volved if family members do not have the
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Partnership in care: paediatric nursing model
f The success of the model depends upon paediatric nurses being able to identify clearly what their role is, and how they should function when faced with particular healthcare problems. 5
Fig. I. Role of the paediatric nurse
achieve a policy of minimal intervention, they must initiate a teaching process where by they share knowledge and teach the fam ily members the appropriate skills so that they can effectively meet the child’s needs. This teaching role must rank as being of unique importance if the nurse is to pro mote healthcare partnership with the child/family. Referral: While the partnership in care model acknowledges that nursing care is unique, it also recognizes that the paediatric nurse may have to refer to other healthcare professionals so that the health recovery of the child and the support of the child’s carers are ensured.
Role diversity appropriate skills or knowledge to ensure a successful healthcare outcome. Although Casey makes a distinction be tween family care and nursing care activit ies, she does not advocate fixed boundaries; Indeed, she recommends a flexible caring approach so that there will be times when the nurse will perform family care activities. Similarly, parents may be able to undertake some nursing activities when they have re ceived appropriate instruction and supervi sion of practice. Partnership nursing aims to establish a relationship of equality be tween the professional carers and the par ents. Support strategies: The nurse must imple ment strategies that enable significant fam ily members to become involved in the care of the sick child, and that demonstrate a sense of trust between the child, parents and healthcare workers. Such a relationship is essential if the parents are to perceive that they are partners in care and, indeed, have a valuable contribution to make. Teaching: A stated objective of the partner ship in care model is to enable the child/family members to meet healthcare needs with minimal intervention from healthcare professionals. However, many problems require specialist skills and knowledge. Therefore, if nurses want to K E Y P O IN T S • The child/parent relationship is unique. • Parents can be very effective carers In the hospital setting. • The partnership in care model is flexible and utilizes fundamental concepts of paediatric care within its framework. • The success of the model is dependent on the commitment of healthcare workers to encourage an active partnership with parents.
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It is evident that the role of the nurse is diverse. The success of the model depends upon paediatric nurses being able to ident ify clearly what their role is, and how they should function when faced with particular healthcare problems. The challenge of the partnership model is to put into practice what has for so long been a fundamental belief of paediatric nurses, i.e. that parents are the most appropriate carers for children both in health and sickness. Failure by healthcare professionals to harness and util ize parents’ unique contribution to the re covery of sick children may lead to ineffec tive care, impaired recovery, parental feel ings of low esteem and a sense of frustration in healthcare workers. The partnership model is a valuable means of planning, im plementing and evaluating the care of the paediatric patient.
Conclusion The partnership in care model is a flexible nursing model. Its main aim is to highlight the fact that parents are able and willing to be effective carers and that the major re sponsibility for the healthcare of the sick child rests with them, with minimal health care worker input. However, the model also allows for extensive care giving by the healthcare professional when this is indi cated and appropriate. Only when the full participation of the child’s significant carer is gained will the child’s potential for nor mal development be regained and the integ rity of the family unit be restored. ]® T Casey A (1988) A partnership with child and family. Sen Nurs. 8 (4): 8-9 Court SDM (1976) Fit For The Future (Report of the Committee on Child Health Services) 1: 99 Platt H (1959) The Welfare o f Children in FIospitai. Report of the commission, Department of Health, Central Health Service Council. HMSO, London
British Journal of Nursing, 1992,on Voi l,N o45, 2019. Downloaded from magonlinelibrary.com by 131.172.036.029 January
Partnership in care: paediatric nursing model Michael Farrell, Hospitals for Sick Children, London In 1988, Casey developed her partnership in care model for use within the paediatric healthcare setting as she felt that other models did not recognize or emphasize concepts that she deemed essential for effective paediatric care. This has now been adopted by the Hospitals for Sick Children as the model of care.
‘T
A he care of children, well or sick, is best carried out by their families, with varying degrees of assistance from members of a suitably qualified healthcare team whenever necessary’ (Casey, 1988). The unique contribution that parents make to the lives of their children has been well established and recognized. Any care of the sick child requires the involvement of the parents if the care is to be effective (Platt, 1959). A similar view is expressed in the Court report (1976) which states that healthcare professionals should provide an environment that will: ‘achieve a unity of preventive and curative medicine which in cludes partnership with parents.’ This re port went on to state that it is only when a partnership exists between significant family carers and healthcare workers that the sick child’s recovery will be promoted. Unlike other nursing models, Casey’s model clearly identifies the significant con tribution that parents make to the care of the sick child. This concept forms the fundamental philosophy of the model.
Concepts Casey’s partnership in care model com prises five main concepts: The child From birth, the needs of a child are very much dependent on other people. The ma jority of these needs are met by the child’s parents or other family members. How ever, as children develop new skills and knowledge, they are more able to meet their own needs. This enables them to become more independent from their primary caregivers until that time when they achieve full independence.
Mr Farrell is Charge Nurse, Intensive Care Unit, Hospitals for Sick Children, Great Ormond Street, London
Health Casey defines health as being that state of optimal physical and mental wellbeing that should be present at all times if a child is to achieve his/her full potential. If an un
British Journal of Nursing, 1992,Vol l,N o4
identified or unrectified health deficit is present, this may compromise the child’s physical, psychological, intellectual, social and spiritual development. Environment A child’s development can be affected by a number of stimuli. Casey considers that those which originate from external sources, i.e. from outside the self, occur as a result of a child’s environment. She fur ther considers that the child needs to per ceive that the external environment is safe, caring and loving if development and inde pendence are to be promoted. Family Casey recognizes the difficulties inherent in trying to define the concept of the family. For the purposes of the model, the family is described as a unit of individuals who have the major responsibility for the giving of care to the child and exercise a strong influence upon the child’s development. While parents take on the main caring re sponsibilities, the model does not preclude the involvement and influence of others. Care given by family members, or in deed the care that the child gives himself/herself, is known as family care. This encompasses care activities that meet the child’s everyday needs. Paediatric nurse The paediatric nurse has a number of re sponsibilities to fulfil in order to function effectively as a healthcare professional. Casey describes the concept of the nurse with regard to the actions that she performs (Fig- /)■ Care: The partnership in care model ident ifies the care given by the nurse as nursing care. In the context of the model, the nurse should only perform nursing procedures or give skilled nursing care when it is appro priate, i.e. the nurse will only become in volved if family members do not have the
175
Downloaded from magonlinelibrary.com by 131.172.036.029 on January 5, 2019.
Partnership in care: paediatric nursing model
f The success of the model depends upon paediatric nurses being able to identify clearly what their role is, and how they should function when faced with particular healthcare problems. 5
Fig. I. Role of the paediatric nurse
achieve a policy of minimal intervention, they must initiate a teaching process where by they share knowledge and teach the fam ily members the appropriate skills so that they can effectively meet the child’s needs. This teaching role must rank as being of unique importance if the nurse is to pro mote healthcare partnership with the child/family. Referral: While the partnership in care model acknowledges that nursing care is unique, it also recognizes that the paediatric nurse may have to refer to other healthcare professionals so that the health recovery of the child and the support of the child’s carers are ensured.
Role diversity appropriate skills or knowledge to ensure a successful healthcare outcome. Although Casey makes a distinction be tween family care and nursing care activit ies, she does not advocate fixed boundaries; Indeed, she recommends a flexible caring approach so that there will be times when the nurse will perform family care activities. Similarly, parents may be able to undertake some nursing activities when they have re ceived appropriate instruction and supervi sion of practice. Partnership nursing aims to establish a relationship of equality be tween the professional carers and the par ents. Support strategies: The nurse must imple ment strategies that enable significant fam ily members to become involved in the care of the sick child, and that demonstrate a sense of trust between the child, parents and healthcare workers. Such a relationship is essential if the parents are to perceive that they are partners in care and, indeed, have a valuable contribution to make. Teaching: A stated objective of the partner ship in care model is to enable the child/family members to meet healthcare needs with minimal intervention from healthcare professionals. However, many problems require specialist skills and knowledge. Therefore, if nurses want to K E Y P O IN T S • The child/parent relationship is unique. • Parents can be very effective carers In the hospital setting. • The partnership in care model is flexible and utilizes fundamental concepts of paediatric care within its framework. • The success of the model is dependent on the commitment of healthcare workers to encourage an active partnership with parents.
176
It is evident that the role of the nurse is diverse. The success of the model depends upon paediatric nurses being able to ident ify clearly what their role is, and how they should function when faced with particular healthcare problems. The challenge of the partnership model is to put into practice what has for so long been a fundamental belief of paediatric nurses, i.e. that parents are the most appropriate carers for children both in health and sickness. Failure by healthcare professionals to harness and util ize parents’ unique contribution to the re covery of sick children may lead to ineffec tive care, impaired recovery, parental feel ings of low esteem and a sense of frustration in healthcare workers. The partnership model is a valuable means of planning, im plementing and evaluating the care of the paediatric patient.
Conclusion The partnership in care model is a flexible nursing model. Its main aim is to highlight the fact that parents are able and willing to be effective carers and that the major re sponsibility for the healthcare of the sick child rests with them, with minimal health care worker input. However, the model also allows for extensive care giving by the healthcare professional when this is indi cated and appropriate. Only when the full participation of the child’s significant carer is gained will the child’s potential for nor mal development be regained and the integ rity of the family unit be restored. ]® T Casey A (1988) A partnership with child and family. Sen Nurs. 8 (4): 8-9 Court SDM (1976) Fit For The Future (Report of the Committee on Child Health Services) 1: 99 Platt H (1959) The Welfare o f Children in FIospitai. Report of the commission, Department of Health, Central Health Service Council. HMSO, London
British Journal of Nursing, 1992,on Voi l,N o45, 2019. Downloaded from magonlinelibrary.com by 131.172.036.029 January
